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Cover Story: Danger Ahead?

Football has come under attack from medical professionals, politicians, and even former players. Saving the sport may require turning it on its head—in order to find real remedies for its risks.

This article first appeared in the August/September 2016 issue of Athletic Management.

By Dennis Read

Dennis Read is an Associate Editor at Athletic Management. He can be reached at: dr@MomentumMedia.com.

For more than 40 years, football has been an integral part of Brad Garrett’s life. First as a player, then as a coach, and now as Assistant Executive Director at the Oregon School Activities Association and outgoing chair of the NFHS Football Rules Committee. So when his wife said she wasn’t sure their 11-year old son should play tackle football, it drove home the challenges facing those promoting and overseeing the game.

“I believe my wife knows football as well as any parent out there,” Garrett says. “And she knows what the game has meant to me and the positive impact it’s had on my life. So when she questioned our son playing, I knew it was a real concern. And it reflects the thinking of a lot of moms and dads out there.”

It also parallels the feelings of a growing number of people in the public eye. Two doctors from the University of Minnesota have recommended that schools end their football programs. A man in Las Vegas is running for the Clark County (Nev.) school board on the sole platform of banning football. NFL Hall of Famer Harry Carson has said he doesn’t want his grandchildren to play football, while several other NFL players say they will either discourage their sons from taking up the sport or make them wait until high school before playing full tackle football.

The concern is primarily due to advances in understanding the dangers of concussions. And as more research is conducted, fears continue to escalate. The most recent studies have found that players don’t have to display obvious signs of concussion to be affected, as repeated subconcussive hits have been shown to cause brain damage.

According to data from the Sports & Fitness Industry Association, football participation among youth and teen age groups is down nearly 20 percent since 2009. There’s no way to determine how much of the decline is attributable to injury concerns as opposed to other factors, such as sport specialization, increased interest in non-traditional sports, and demographic trends. But those at the front lines of the game believe there’s been a sea change in the way the general public views football.

“There’s always been a subset of parents who wouldn’t let their kids play football,” says Kurt Jaeger, who is entering his 14th year as Athletic Director at Providence Academy in Plymouth, Minn. “But it seems like the division has deepened. People are choosing sides and it’s become political and emotional. We’re hearing from families who have lost friends because they decided to let their son play tackle football and their friends have not.”

In Garrett’s view, nothing less than the future of the sport is at stake. “We have to be the guardians of the game and make the necessary changes,” he says. “I can’t imagine not having high school football, but it could come to that if we don’t make every effort to minimize unnecessary risk.

“I understand the fear—no parent wants to expose their child to something that could debilitate them down the road,” Garrett continues. “That’s why it’s so important for those of us who love the game to make it as safe as possible. That’s the only way my son will be able to play, and hopefully his son after him.”

IN THE HEADLINES

At the root of most safety concerns is concussions. Headlines carry news of former pro football players who have taken their own lives and later been diagnosed with CTE, a degenerative brain disease associated with blows to the head. Other ex-players, including former quarterback Jim McMahon, say they face issues such as depression and dementia due to head injuries sustained during their playing days. A suit filed against the NFL by former players was settled for more than $1 billion, while the NCAA and several of its member schools and conferences face lawsuits from former football players after a proposed settlement of a class action case involving athletes in all sports did not include payments to them.

While other sports, especially ice hockey, have similar stories about the challenges faced by former players, they haven’t created the same level of alarm as those associated with football. Scott Oliaro, Associate Director of Sports Medicine and Athletic Trainer at the University of North Carolina, thinks this is largely because of the size and media attention devoted to the sport. “Football is still the most popular sport in the country, and NFL players are among the biggest superstars our society has,” says Oliaro, who was part of the Safety in College Football Summit that met in January 2014 to address concussion issues. “So when a football player takes his life and is found to have CTE, it’s a bigger story than if he had played another sport. But these dangers are an issue in all contact sports, not just football.”

Compounding the issue for football is the number of players on a team. “I’m of the mindset that once you fall below 40 players in a high school, you’re in jeopardy because it makes it harder to field a sub-varsity team,” Jaeger says. “You’ll have some 14-year-old freshmen playing against 18-year-old seniors, which is a really bad combination from both an injury and a morale standpoint. Many of those freshmen who have to play varsity wind up dropping out well before their senior year.”

Last fall, Jaeger’s school failed to field a seventh and eighth grade team for the first time in years. Although the varsity squad expects 12 seniors back this fall, having enough players to form a program down the road is a question mark. “We see first, second, and third graders playing football on the playground, so we know they’re interested in the game,” Jaeger says. “But when it comes time for them to sign up for the team in seventh grade, we get nobody. It’s not because they suddenly don’t like to play anymore, it’s usually because the parents don’t want them to.”

SAFETY FIRST

Roger Blake, Executive Director of the California Interscholastic Federation, has heard similar stories in his area of the country, which is why he feels the number one solution is a coordinated effort among athletic administrators and coaches nationwide to understand, embrace, and promote issues of safety in football. “When parents watch their sons and daughters participate in sports, they need to see our coaches using the best practices, as demonstrated by science, to keep them safe,” he says. “We have to listen to the medical experts and put their advice into practical application.

“And we can’t be slow about it, like we have been in the past,” Blake continues. “We have to be proactive because the science will change as we learn more.”

Proper efforts begin with adequate medical coverage. “I believe a certified athletic trainer is, by far, the most valuable sports medicine resource a school can have,” Blake says. “It’s the best tool to reduce risk and minimize injuries, and it’s the best asset for helping students return safely from an injury, be it a concussion or a turned ankle. I constantly urge superintendents and school boards to find ways to fund these positions.”

Recent numbers from the Korey Stringer Institute show that about 70 percent of high school athletes have access to athletic training services. However, only 48 percent of high schools indicate they have daily practice coverage and only 37 percent have full-time athletic trainers on staff.

At the college level, schools are recognizing that proper medical coverage also means athletic trainers report to someone outside the athletic department. New rules in the Power 5 conferences that went into effect Aug. 1 require sports medicine personnel to have unchallenged and autonomous authority over medical management and return-to-play decisions. They also mandate that a physician serve as the institution’s medical director and oversee medical care providers and medical services for student-athletes. In June, the NCAA’s Committee on Competitive Safeguards and Medical Aspects of Sports recommended all divisions adopt similar legislation.

At the University of North Carolina, athletic trainers have been reporting to the director of campus health services for several years. “When an athletic trainer is hired by a coach or reports to an athletic administrator, sometimes there can be a conflict of interest,” Oliaro says. “Here, everyone understands that medical decisions are made by medical personnel. That doesn’t mean there isn’t pressure to get athletes back on the field, but when the sports medicine staff has autonomy, better medical decisions are made.”

However, even in this medical autonomy model, administrators can’t completely take a back seat. “The athletic director needs to understand the decision-making that’s gone into our plans, policies, and procedures,” Oliaro says. “In our program, it has actually been a collaborative effort. Our athletic director knows and supports our policies, and he’s even helped improve them.”

Another important step is following the science and data closely since new information is constantly being learned about the effect playing football has on the body. North Carolina has been using helmets outfitted with impact sensors to measure the forces players experience during practices and games. In addition to spurring reductions in full contact practices, the devices have helped determine the plays and techniques that pose the greatest risks.

“If a player hits his head during a certain drill, the coach can review it with him on film,” Oliaro says. “Then they can work on his technique to avoid that happening in the future.”

Sometimes, the data can reveal intriguing nuggets of information that have a surprising impact. “We found that we had only one concussion during practices where players were wearing just shoulder pads and helmets,” Oliaro says. “Yet when they wore full pads, including knee and thigh pads, we saw a number of concussions, even though the practice activities were exactly the same. So now more of our practices are in half pads.”

CHANGING THE RULES

Hand in hand with proper medical coverage is reducing the number and severity of hits to the head. This is where rules changes can make a big difference.

To lessen dangerous hits during games, Oregon was one of four states using an experimental rule last season that barred blindside blocks. While current rules do not mention blindside blocks by name, the experimental one defines them as “any block toward the blocker’s own end line or against an opponent who because of his physical positioning and focus of concentration is especially vulnerable to injury” and makes them illegal unless initiated with open hands.

“Every coach has had a player lit up by a blindside block, but it’s a dangerous play, especially since blocking a defender can be accomplished in a safer way, by leading with the hands,” Garrett says. “We want to change the culture away from a play like a blindside block being applauded and rewarded with a helmet sticker to where it’s avoided at all costs.

“I tell people I’ve never seen anyone celebrate a pulled face mask,” he continues. “We know that’s not right and can severely injure a player. Now we have to get to that point with unnecessary and excessive contact situations like blindside blocks. You do that by enforcing a severe consequence when it happens.”

Although the experimental rule fell just short of being added to the official NFHS rule book for 2016, several other states will test it out in addition to Oregon. Garrett hopes it will become a national rule in the future.

“Football is blocking and tackling, and they will never be eliminated from the game,” he says. “But by making certain types of techniques illegal, we can reduce the number of times players are unnecessarily placed in harm’s way.”

In addition to rules governing on-field action, attention is increasingly being paid to the number of hits during practice, in order to address concerns about subconcussive impacts. Many collegiate conferences have limited full contact practices to two days a week, and the Ivy League went even further last year, eliminating all full contact practices during the regular season. The move was inspired by Dartmouth College Head Coach Buddy Teevens who started cutting back on tackling in practice in 2010. “Unless we change the way we coach, we won’t have a game to coach,” he told a Congressional committee in the spring.

Despite the ban on tackling teammates, Big Green players still get plenty of practice by utilizing a moving tackling dummy that stands 6-foot-1, weighs 200 pounds, and can “run” a 40 in 4.8 seconds. A low-tech option many teams are using is a tackling ring, a large (typically 40 to 48 inches) padded object that is rolled across the field for players to take down.

At the lower levels, it is important to teach safe techniques, and many programs are using the Heads Up program from USA Football, which trains and certifies coaches in several areas of player safety, including tackling, blocking, heat stress, and equipment fitting. This fall, Oregon becomes the first state to require all of its high schools to be Heads Up Football certified, with penalties ranging from fines to forfeiture for those that fail to comply.

Although the OSAA does not have jurisdiction over middle school programs in the state, Garrett expects that the coaches of younger squads will follow the lead of their high school colleagues and adopt Heads Up Football techniques. “We know our football coaches have direct influence over their middle school programs,” he says. “By requiring high school programs to be Heads Up certified, it’s very likely that middle school teams will be as well, which we feel will help make the game safer and keep kids involved in the sport longer.”

Oliaro points out that change doesn’t always come easy, however. “It’s hard to ask athletes to alter the way they’ve been playing the game their whole lives,” he says. “It’s going to take a little time for the generation of players who were taught at an early age to separate the receiver from a ball using their head to get through the system. But I also think these plays need to result in penalties—officials enforcing the rules regarding head-to-head contact will make the biggest difference.”

OUTSIDE THE BOX

While safety measures are critical, their effects will be gradual. In the meantime, there is still the problem of low participation numbers right now. Some feel more radical solutions are needed, and Jaeger is one of them. His school is a member of the Independent Metro Athletic Conference (IMAC), which will introduce something called Fusion Football at the seventh and eighth grade level this fall.

Last year, the IMAC saw turnout at four of its member high schools drop to the point where combined teams were needed. At Providence Academy, where there were enough players for a varsity and junior varsity squad, the seventh and eighth grade team was shuttered due to a lack of players.

Knowing that many parents were reluctant to let their kids play football, the league called a public meeting of administrators, coaches, and a local doctor to explore how to address those concerns. Jaeger suggested finding a way to reduce the amount of contact younger players would be exposed to, which received mixed response until one of the coaches spoke up to endorse it. “He said, ‘We can continue to do what we’re doing and hope things change. But football is dying in our schools, so maybe it’s time to make a leap and try something different,’” Jaeger says.

The result is Fusion Football, a mix of flag and contact football that uses a specially designed vest—a product called the Tackle Bar—with three batons attached to it by velcro. The two on the back run from the bottom of the shoulder to the hip while the one on the front is parallel to the ground just above belt height. Ball carriers are ruled down when one of the batons is removed from their vest.

Jaeger says batons are a vast improvement over flags, which typically dangle below the hip in flag football. “The tackle bars are located exactly where the eyes should be pointed during a tackle,” he says. “It puts defenders in a position where they’re not reaching for something on the side of the hips or reaching through the target area like they can with flags. This teaches them to keep their head up and look at the waist or the torso, which is the same position we want them in when tackling.”

Although the Tackle Bar system can be used with unpadded players, Jaeger says Fusion Football will employ traditional football padding. This will allow players to block the same way as in contact football. However, there will be no downfield blocking, offensive linemen will not be allowed to pull, and defensive linemen will not be allowed to bull rush. Wearing full pads allows the players to get more of the full football experience, which will be enhanced by holding Fusion games immediately before varsity contests on the same field.

And even though tackling will be banned during games, the seventh and eighth graders will be introduced to it during practices throughout the season. “This way they can learn to tackle and be tackled in a controlled environment with a coach right there,” Jaeger says. “They can focus on learning the proper techniques instead of trying to stop the opponent.”

Jaeger says initial response has been positive, with each school in the league expecting to have enough players to field a team and some possibly having two. The group he’s heard complaints from are parents of seventh graders who have already played full contact at the youth level.

“Not only are we battling the perception that football is bad for kids, we’re also battling the other extreme where people feel we’re delaying an athlete’s progress by not having them tackle,” Jaeger says. “We explain that we’re not eliminating tackling, we’re just not going to do it in game situations where we have no control.”

In addition to starting Fusion Football, the league will also add non-contact flag football for fifth and sixth graders. In the past, the school offered no football until seventh grade, and Jaeger feels that getting students involved in the sport at a younger age will pay off down the road.

“We felt it was important to offer families a vertical program that takes players from flag football through to full tackle football in high school,” he says. “We hope to get as many kids involved as we can. We know there will be drop off points along the way, and that’s okay. But if there are students who never try the game because of perceived safety issues that we can correct, then it’s shame on us.”

ATHLETIC DIRECTOR’S ROLE

While Jaeger has gone above and beyond by developing a new way to play football, there are plenty of other things any athletic director can do to help make the game as safe as possible. One involves supervision of coaches.

“It’s the athletic director’s responsibility to make sure their coaches are educated, because so many of these problems can be solved, or at least minimized, with proper education,” Blake says. “Coaches need to know about the signs and treatment of concussions. They need to understand heat illness and sudden cardiac death. Coaches are involved with the sport because they love the game, but they have to know about safety and medical issues too.”

He also wants to increase athletes’ knowledge, specifically about head injuries. “We need to educate kids on the signs and symptoms of concussions,” Blake says. “They’re the ones who will see that a teammate isn’t acting right in the huddle, and they need to know what to do when that happens.”

Just as important, athletic administrators have to take a leadership role, getting out in front of the public to explain what steps their program is taking. “Athletic directors need to tell their communities all the great things that they’re doing to protect the health and safety of the student-athletes,” Blake says. “Parents won’t know about the training coaches have to go through if we don’t tell them. They won’t know about the services athletic trainers provide if we don’t tell them. Athletic directors have to be their own PR people when it comes to health and safety. They can make a difference by showing parents all the steps taken to keep their children healthy.”

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Parental Advisory

Just as generations of colleagues have done for years, Larry Busichio, Athletic Director at Columbia High School in Maplewood, N.J., stopped by his feeder middle schools in June to talk with soon-to-be ninth graders about playing sports, including football. What happened afterwards, however, was unlike anything his peers typically experience.

A group of parents were not only upset with Busichio’s visit, they were incensed. Their concern was about the safety of football and CTE, and they felt it was irresponsible for a high school athletic program to encourage their sons to join the football team without parental knowledge and approval.

The parents wrote a 600-word letter to the district superintendent and the middle school principal, demanding change. They said they were “outraged by both the incomplete information that was presented at the meeting and by the circumvention of parental guidance.” And they asked that the school make “sure both parents and students are honestly informed of the risks of football, including CTE, before the end of this school year.”

The take-away for administrators from the incident is to be hyper-aware of best methods for communicating with parents about the sport of football. It may no longer be okay to encourage students to join a football program without talking to their parents first.

So what are ways to get parents on board? The Heads Up Football program suggests encouraging dialog with players’ families throughout the season. It requires each certified program to have a designated Player Safety Coach whose responsibilities include holding a clinic to show parents what the staff is teaching the players.

In Minnesota, when the Independent Metro Athletic Conference held a meeting to address a decline in football participation at member schools, it invited parents to attend and streamed it on the Internet. It also had a pediatrician and neurosurgeon on hand and opened the floor to questions and comments from the audience.

“We promoted it heavily at our schools and had hundreds of people attend or watch the stream,” says Kurt Jaeger, Athletic Director at Providence Academy and one of the panel members. “We also held private meetings with any family that requested one. We want the parents to see that we’re doing all we can to keep our athletes as safe as possible.”

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